VBS Registration 2023

July 17 - 21, 2023 | VBS - Stand Firm

July 17-21, 2023 from 10:00 am - 1:00 pm

Eligible Ages: Kindergarten (5 years old) - Completed 5th Grade

(Our preschool age classes have already been completely filled.)

Child's name

*

Child's Date of Birth

*

Child's Age

*

Please select one option.

5 6 7 8 9 10 11

Child's Gender

*

Please select all that apply.

Male Female

What Grade Is Your Child Going Into Fall of 2023?

*

Please select one option.

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Parent's Email

*

This address will receive a confirmation email

Parents / Guardians

*

Address

*

Home Phone

*

Cell Phone

*

Emergency Contact name and phone number

*

Medical Conditions (if child has no allergies, write none)

*

Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

*

Please select one option.

Yes, I agree No, I do not agree

Description

July 17 - 21, 2023

VBS - Stand Firm

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